early detection and intervention for the prevention of psychosis

Conditions: Schizophrenia; Bipolar Disorder; Depression; Psychotic Disorders

Summary: edipp is a multisite trial of early identification and intervention to prevent the onset of psychosis in adolescents and young adults, carried out at six sites across the united states. the hypothesis is that very early identification and intervention will be effective in delaying or preventing onset of psychosis and improving social and occupational functioning.

the study is structured as a cutoff, regression discontinuity design, in which lower risk-for-psychosis participants will not be treated by protocol but followed up for two years. those at higher risk will be treated with anti-psychotic, antidepressant and mood stabilizing medications by symptom indications, and systematically provided psychoeducational multifamily group treatment, supported education and employment, and intensive clinical case management, using key elements of assertive community treatment. both arms of the study will be followed for two years and assessed at 6, 12, and 24 months. outcome measures include rates of conversion to psychosis, relapse of psychosis, development of psychotic disorder diagnoses, levels of positive, negative and general symptoms, social and vocational functioning, family functioning, and neurocognitive functioning. the six sites include sacramento, california; salem oregon; and surrounding counties, ypsilanti and washtenaw county, michigan; portland, maine; albuquerque, new mexico and glen oaks, new york. in addition to symptomatic and functional outcomes, impact on incidence of psychotic disorders, including schizophrenia, will be assessed, as will cost-benefit effects.

Eligibility criteria:
inclusion criteria: * subjects in the age range of 12-25 and living in the experimental catchment area may be enrolled in the edipp study based on meeting at least one of the inclusion requirements and none of the exclusion criteria; * screening process indicates symptoms equivalent to a minimum rating of '1' on at least one positive symptom of psychosis; * screening process indicates a likely family history of first degree relative with psychotic illness plus a deterioration in functioning equivalent to a 30% drop in functioning score over the past year; or * screening process indicates a likely history of schizotypal personality disorder plus a deterioration in functioning equivalent to a 30% drop in functioning over the past year. exclusion criteria: * outside the age range of 12 to 25 years; * history of intelligence quotient (iq) below 70 (based on school records, not tested at pier); * more than one month duration of psychosis (guided by the criteria of at least one 6 on the positive symptom sub-scale of the scale of positive symptoms (sops); * history of previous psychotic episode, whether or not treatment was received; * taken antipsychotic medication for more than 30 days at a therapeutic dose for psychotic symptoms; * either the young person being screened for the study or both parents do not speak proficient english; * female is pregnant at baseline (inquired on the screening interview); and * subject is a prisoner.

Keywords: schizophrenia bipolar disorder psychosis prodromal psychosis family psychoeducation supported education supported employment ulra-high-risk for psychosis major depression bipolar disorder, with psychotic features major depression, with psychotic features attenuated, prodromal psychotic symptoms